Early the next morning, I came to the hospital.
"Boss Zheng, someone is looking for you. They arrived early in the morning." The doctor on duty told Zheng Ren.
"Where are the people?" Zheng Ren asked.
"I said it was your fellow countryman, so I told him to go to the office and wait."
After changing clothes, Zheng Ren came to the office.
Liu Zewei arrived early and was very busy today as he had to discharge patients and admit patients.
Moreover, it is very likely that these patients will go to a community hospital after the first stage of surgery for one day of observation.
So he came very early to welcome a bright future and witnessed a huge jump in Boss Zheng's career.
Although he had countless things to do, he was chatting with an ordinary middle-aged man. The man was holding a thick film bag in his hand, and he knew at a glance that he was the man that Old Director Pan was talking about.
"Hello, are you the patient's family member the director mentioned?" Zheng Ren came in and asked directly.
"This is Boss Zheng." Liu Zewei introduced.
The middle-aged man is extremely ordinary in appearance and clothing, and he looks honest.
Although he was surprised that Zheng Ren was so young, he still bowed honestly to show his respect for Boss Zheng.
After being introduced by others, when they came to see a doctor in the imperial capital, they were generally anxious to seek medical advice. This is a door-to-door job asking for help. First of all, you need to have a correct attitude.
Zheng Ren smiled and asked, "The patient is your lover? Tell us about the situation."
As he spoke, he took the film from the patient's family.
"Mr. Zheng, the patient is my wife. She is 42 years old. One month ago, she said she had pain around her belly button. The pain immediately relieved after the initial pain. She thought it was diarrhea or something, so she didn't care." The middle-aged man said.
Zheng Ren nodded, indicating that he knew, and started to look at the time on the film.
By looking at the patient's condition in chronological order from the very beginning, you can have a better understanding of the condition.
"The first attack didn't last long, so I didn't take it seriously. But two or three days later, my stomach hurt again. The pain became more and more frequent. I was worried that something serious was going on, so I took her to the hospital for treatment. One glance.”
Zheng Ren found the film from 23 days ago, took it out and inserted it into the film reader.
The time is not 1 month, but it is normal for the patient’s family members to narrate the incident to have slight deviations.
It was a plain abdominal radiograph in an upright position. No free air shadows were seen under the two diaphragms. There was slight pneumatosis in the left colon and two "irregular" small gas-liquid planes were seen in the right lower abdomen. No other obvious special changes were seen.
This "small" air-fluid level in the right lower abdomen is considered to be a high possibility of incomplete intestinal obstruction, and there is no problem in the diagnosis of Haicheng City No. 1 Hospital.
"It was checked at that time..." The middle-aged man began to look at the film bag, and after comparing the time, he said: "This is the film. The diagnosis is incomplete intestinal obstruction. It is recommended that we go back for observation."
There are many predisposing factors for incomplete intestinal obstruction. You can be admitted to the hospital for observation or you can go home for observation.
Zheng Ren considered that the doctors in Haicheng's emergency department found no triggering factors after consultation, so that's why he made this suggestion.
At most, just use some Kailu or something, that's enough.
He knew the doctors in Haicheng's emergency department very well.
Although there are minor problems, there is no special treatment, and it is difficult for patients and their families to accept being hospitalized.
"What happened next?" Zheng Ren asked casually as he took the test report from that time and started to look through it.
"After I got home, I got better after the period of pain. After that, it hurt for a while almost every day, and it only took about 20 minutes." The middle-aged man said: "When it doesn't hurt, I'm like a good person, so My wife and I didn’t care.”
"Three days ago, I had another abdominal pain. This time it didn't get better. I was so painful that I broke into a cold sweat." The middle-aged man said, "I had no choice but to call 120 ambulance and send her to the hospital."
"The diagnosis in the emergency department was 'acute abdomen', and they said they needed to be observed in the emergency room. I didn't think it was the right thing, so I asked someone to find Director Sun and go to the second department of general surgery for hospitalization."
Zheng Ren smiled, picked up the inspection at that time, and looked at it carefully.
Imaging examination showed that the symptoms were indeed incomplete intestinal obstruction, but the symptoms were much more severe than last time.
This can also be judged when the patient's family members describe the medical history.
The same goes for blood tests and other tests, which are consistent with imaging judgments.
The white blood cells in the blood routine were slightly higher, and the neutrophils were also higher. Low hemoglobin, middle-aged women, and anemia are not uncommon.
Zheng Ren pondered and read the test sheets one by one.
Liver function... Aminotransferase is a bit high? There doesn't seem to be much of a problem. Bilirubin was normal, and other changes were not sufficient to make a diagnosis.
After admission, the Second Department of General Surgery provided symptomatic and supportive treatment such as fasting, gastrointestinal decompression, defecation, fluid rehydration, somatostatin to inhibit intestinal juice secretion and anti-infection.
The diagnosis was clear and the treatment was quite satisfactory, which was in line with Director Sun's style. Smooth, absolutely stable.
However, the patient's abdominal pain was not relieved after treatment. Later, he underwent a transoral enteroscopy, which revealed: descending duodenal diverticulum, non-atrophic gastritis with bile reflux.
Gastroscopy also diagnosed the patient with atrophic gastritis.
Isn't this very common? A 42-year-old has atrophic gastritis
But it's not a big deal. It's just rare, not even rare.
Zheng Ren made his own judgment in his mind while looking at the test results.
I looked through the test sheets and saw many questions, but none of them were major and I couldn't give a clear diagnosis at all. In other words, Director Sun's diagnosis was correct, and Zheng Ren had no objection to it for the time being.
Zheng Ren inserted the abdominal CT into the reader, held his chin with his right hand, and read the images carefully.
"Boss, there seems to be something wrong here. It's quite obvious intestinal obstruction, why is it bad?" Su Yun stood aside and pointed to the location of the obstruction on the film and said.
Zheng Ren nodded and continued reading the film.
After reconstruction, the entire image looks a lot wrong.
The renal tubules are atrophied, which does not look like a 42-year-old middle-aged woman, but more like the imaging findings of a person in their 70s.
Excessive aging
Zheng Ren recalled some clinical case reports, and the diagnosis was directly rejected by him.
"What medicine does your wife usually take? Apart from stomachache, does she have any other discomforts?" Zheng Ren asked while watching the movie.
"It's not like I'm over 40, I'm in menopause, and my temper is a bit grumpy." The middle-aged man thought for a while and said: "They always say that I have no future and can't make money. I used to cook for me, but in recent years I have been If I don’t cook anymore, I’ll just complain every day. Or I’ll dress up and go out to class reunions.”
"..." Zheng Ren quickly stopped the middle-aged man's topic.
If this continues, it may become a family ethics drama.
Seven years...eight years...the itch of more than ten years, I hold my left hand with my right hand, start to pay attention to dressing up, and then go out to meet classmates.
"I'm asking if you feel any discomfort and what medicine you have taken." Zheng Ren asked again.